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3-20. Vital Signs

There are a number of important differences between the vital signs of a child and those of an adult. Note the following:

a. General Information.

(1) A child's vital signs must be checked and recorded more frequently than the vital signs of an adult.

(2) Your subjective impression of the child may be more important than any one of the child's vital signs.

(3) Children have incredible compensatory mechanisms that conceal physiological insult for some time. For example, a child may have a fever (a temperature above normal) and still behave as though he feels fine. So, a child may have an infection and display no signs or symptoms of illness. Sometimes only after the child's coping mechanisms have been exhausted will you see changes in the child's vital signs.

(4) Once a child's vital signs begin to change for the worse, the changes occur rapidly, and the child's condition deteriorates.

b. Blood Pressure.

(1) Younger children generally have lower blood pressures, higher pulses, and higher respiratory rates than adults.

(2) A child's blood pressure should be checked with the correctly-sized cuff. The proper size is about two-thirds of the circumference of the child's upper arm.

c. Respiration.

(1) Younger children generally have higher respiratory rates than adults.

(2) A child or infant's respirations can be checked by placing your hand on his stomach. Take the respiration rate frequently. An increase in the respiration rate may be significant.

d. Shock.

(1) An early warning sign of shock in a child may be tachycardia (abnormally fast heart beat).

(2) Prolonged capillary refill is another early warning sign of shock in a child.

To check capillary refill, use the blanch test. Press on the child's nail bed until you exert enough pressure to cause the area under the nail to show white. To be considered normal, the color in that area should return by the time you repeat the words "capillary refill." That time is approximately two seconds.

e. Heart Beat/Heart Rate.

(1) Bradycardia (abnormally slow heart beat), a worrisome sign in children, may be caused by pressure in the child's skull, depressant drugs, or some comparatively rare medical condition.

(2) A child's heart rate is somewhat higher than the heart rate of an adult. A child's heart rate is heard more centrally in his chest than the adult's heart rate. Therefore, take a child's heart rate by placing the stethoscope below the scapula on the left side of the child's back.

f. Pulse.

(1) In infants and toddlers, the carotid pulse is very difficult to feel because the neck of an infant or a toddler is short. The most reliable pulse to check is the apical pulse. (The apial pulse is taken by placing the stethoscope near the apex of the sternum.)

(2) A child's rapid pulse may be caused by shock, fever, or oxygen deficiency. Fear may also cause a rapid pulse.

(3) The farther away from the heart a child's peripheral pulse can be detected, the better the child's cardiac output.

g. Fever/Temperature.

(1) Each centigrade degree of fever in a child is normally accompanied by a 10 percent increase in pulse and respiration rate.

(2) Children's temperatures are much more important than the temperatures of adults. A child's temperature can change rapidly.

(3) An elevated body temperature in a child can produce these results:

(a) Dehydration:

1 Nausea, vomiting, and fainting.
2 Weak and rapid pulse.
3 Pale skin.
4 Sunken eyes.
5 Shrunken tongue.
6 Skin which remains "tented" after being pinched.
7 Sunken fontanelle (the soft spot) in an infant.

(b) Convulsions. A rapid rise in body temperature may cause a child to have convulsions.

(4) Lower a child's temperature in this manner:

(a) Give the child fluids by mouth.

(b) Sponge bathe the child's face, hands, and feet. If necessary, undress the child and bathe him in tepid water.

(c) Stop bathing the child if he starts shivering.

(5) Low temperature in a child may be a sign of shock or other metabolic problems; for example, near drowning or exposure.

David L. Heiserman, Editor

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Revised: June 06, 2015